In 2014, we attempted to measure air quality through low cost air quality sensors, but the data quality of the sensors was too poor. So we decided to use humans as proxy sensors and measure instead where, when, and how often rescue asthma and COPD inhalers were being used. We ended up crowdsourcing an enormous amount of data and combined it with environmental data to develop predictive models for asthma risk and now share those dynamic models with the public.

The project concluded in 2017: the final report out has been shared with the Robert Wood Johnson Foundation as the funding agency and numerous papers have been submitted to peer reviewed journals for publication. We hope that our learnings will be shared widely and that other institutions will adopt and adapt this work to address their own air quality challenges.

The public served as citizen scientists, agreeing to share their medical information to better their community.
Government officials across multiple agencies worked together in novel, collaborative ways to act on the results of the project - traffic engineering addressed congestion through traffic light re-timings, sustainability worked to plant more trees, public health added their input on the impact for living/working/going to school near busy roadways.

• Enrolled citizens benefited from having a passive method to collect their rescue inhaler usage data and receiving personalized care to increase their asthma free days.
• Citizens throughout the city benefit from having cleaner air to breathe.
• Government officials, for the first time, have hyper local data about where air quality is a challenge and an use that data to create new policies.
  The private partner, Propeller Health, had a large population to validate their product and ability to publish

AIR Louisville helped participants improve their asthma and COPD. Over 12 months, we saw:

• An average of 82% reduction in asthma rescue inhaler use
• 29% of uncontrolled participants gained control of their asthma
• On average, AIR Louisville participants more than doubled their symptom-free days
• AIR Louisville participants slept better, with an average 19% increase in symptom-free nights

Many enrollees felt they received so much benefit from using the device that they requested permission to use it beyond the 12 month program.

There was a subset of the enrollees who failed to use the device for the entire 12 month duration and experienced less of a positive impact.
It is also unclear whether or not enrollees need to continue to use the device or if they have developed long term behavior change for the better.

Part of the success of the Air Louisville project had to do with reciprocity among all stakeholders:

• Citizens had a free, super easy way to track actual rescue inhaler usage (traditionally, they are expected to keep a paper journal) and ability to track location, not just date/time
• Citizens received individual interventions (and remarkably, those interventions resulted in changes to health outcomes measurable by months, not decades)
• Propeller Health received a large scale platform to demonstrate the efficacy of their product and compensation to do so
• Louisville Metro received crowd-sourced, novel data to develop data-driven policies to improve air quality for all
• The Robert Wood Johnson Foundation had an innovative, breakthrough proposal aimed at improving the health for all
• Primary care physicians and respiratory specialists received accurate data to allow them to tailor the patient's treatments

We are in conversations with multiple cities and countries who face similar challenges with air quality and its impact of public health. They are interested in replicating the AIR Louisville project in their own communities.

Define the reciprocity of all stakeholders upfront.